Inspection on 27/11/07 for Queensmead

This inspection was carried out on 27th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Queensmead 11/03/09

Queensmead 08/12/06

Queensmead 23/01/06

Queensmead 17/08/05

Queensmead 31/01/05

Queensmead 26/07/04

Queensmead 02/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Queensmead 1 Bronte Avenue Christchurch Dorset BH23 2LX Lead Inspector Carole Payne Key Unannounced Inspection 08:00 27 & 29th November 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Queensmead Address 1 Bronte Avenue Christchurch Dorset BH23 2LX Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 485176 01202 487805 queensmead@care-south.co.uk www.care-south.co.uk Care South Mrs L Thornhill Care Home 40 Category(ies) of Dementia - over 65 years of age (4), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (4), Old age, not falling within any other category (36) Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 36 in the category OP (Old Age) and 4 in the categories DE(E) and/or MD(E). 8th December 2006 Date of last inspection Brief Description of the Service: Queensmead is registered with the Commission for Social Care Inspection to accommodate 40 older people; this includes 4 places for people with a diagnosis of dementia or mental illness. Queensmead is operated by Care South, a non-profit making organisation with several residential homes and community services across the South West. Mrs L Thornhill is the registered manager. The home is situated in a residential estate close to Christchurch Hospital and one mile from the town centre. Queensmead is a purpose built home set in large, well-maintained grounds. Local shops and amenities are available within a short distance. The premises extend over 3 floors with service users accommodated on every floor. The ground floor comprises of 11 bedrooms, an assisted bathroom, 8 separate toilets, a dining room, three lounges and a conservatory. The first floor houses 15 single rooms, 2 bathrooms, one shower room and two separate toilets. The second floor has the remaining 14 bedrooms, two further bathrooms and two separate toilets. In December 2007, the weekly fees were from £450 to £545 dependent on the level of care needs. Additional charges are made for hairdressing, chiropody, etc. See the following website for further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choos.aspx Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on the 27th and 29th November and took a total of 14.5 hours, including time spent in planning the visit. The inspector was made to feel welcome in the home during the visit. This was a statutory inspection and was carried out to ensure that the residents who are living at Queensmead are safe and properly cared for. Requirements and recommendations made as a result of the last inspection visit and key standards met at the last inspection on 8th December 2006 were also reviewed. The premises were inspected, records examined and the daily routine observed. Time was spent in discussion with seven residents living in the home and four staff members on duty. Survey forms received at the time of writing this report were: Six from residents, nine from relatives / carers or advocates, four from General Practitioners and one from a health care professional. The home also returned an Annual Quality Assurance Assessment (AQAA). Throughout the inspection the management and staff team demonstrated a positive and proactive commitment to addressing any issues raised and continuously improving the quality of life for people living at Queensmead. What the service does well: The service takes exceptional care to ensure that residents moving into the service are reassured that their needs will be met and that they feel welcome and at home when they move in. The home has generally good procedures in place for care planning; care and support delivered is sensitive to the needs and wishes of residents. The home provides a good range of activities to meet the individual needs of residents. Queensmead is a place where residents can truly feel at home and can raise any day-to-day concerns that they have with confidence that they will be both listened and responded to. Confidence in raising any complaints reflects that residents feel safe, and are also protected by the home’s policies and procedures in relation to the protection of vulnerable adults. Queensmead provides a clean and hygienic environment, which is homely for residents. Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 6 Staff members are well trained, so that they can develop the skills that they need to care for residents and meet their needs. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service takes exceptional care to ensure that residents moving into the service are reassured that their needs will be met and that they feel welcome and at home when they move in. EVIDENCE: Nine residents returning survey forms said that they had received enough information before moving in. Pre-admission assessments were viewed for two people who had recently moved into the home. Thorough details had been recorded regarding the prospective residents personal; health and social care needs, as well as their choices and preferences. As appropriate information had been sought from external health and social care professionals. Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 9 The deputy manager normally undertakes pre-admission assessments. One resident was moving in on the first day of the inspection and was made welcome by the manager, deputy manager and staff members. During the day every effort was made to ensure that the resident was made to feel reassured and very welcome. Care was taken to ensure that at important times during the day, such as mealtimes, that the new resident was able to speak to other people living in the home and make new friendships. On the second day of the inspection two new residents were happily engaged in an organised activity. One new resident said ‘they are very nice here.’ (The staff) Attention was also given to the needs of another resident who had recently moved in to make sure that they had everything that they needed to make them feel at home. Staff members at Queensmead spent time talking to a new resident, to find out if they have any concerns and to ensure that they felt comfortable about going into the communal areas and meeting other residents. The manager made sure that she had time to spend with the resident and their relatives, so that they felt reassured. Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has generally good procedures in place for care planning; care and support delivered is sensitive to the needs and wishes of residents. Areas of concern in relation to care and medication handling are currently not affected by the good outcomes residents experience in care delivery. EVIDENCE: Care plans were viewed for four people living in the home. Detailed assessments are completed outlining residents’ personal, social and health care needs, as well as their choices and preferences about what they would like to do doing during the day; these inform care planning, enabling staff to deliver individualised care. Two residents said that they feel very well cared for and that they are well supported by the staff team. During the visit staff members were observed meeting the every day needs of residents; they did Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 11 this in a sensitive manner and were knowledgeable regarding the individual needs of residents. The deputy manager has been working with staff members to improve the standard of care planning to promote the informing of care delivery. A resident had signed one care plan seen. The deputy manager stated that people are consulted regarding their wishes to be involved in care planning and progress is being made in recording preferences. Most residents’ needs were well described in the care records seen and included reference to personal, health and social care needs, as well as the specific needs of residents. It was noted that for one resident a key need in relation to mental health, was described in daily records and the care team were clearly adopting strategies to lessen the resident’s anxiety. This need had not been included in care planning so that care is coordinated and monitored, and the needs of the resident met. Another care plan said that twenty-four hour care is needed in the staff environment to ensure safety and prescribed medication to meet the needs of sight impairment. One resident returning a survey form said that ’sight problems do not always seem to be considered.’ From observation great care is taken to support people in moving about the home and being orientated to their environment. This care needs to be reflected in the care plan. It was clear that staff members knew residents needs well and responded when residents needed assistance. One care plan seen did not state how often care is given, for example ‘regular’ toileting. One care plan identified that a resident was at risk of absconding and that a record needed to be kept of what the resident was wearing each day. This had not been recorded since October 2007; however, the deputy manager confirmed that this is no longer a risk. The care plan had not been updated. Risk assessments include risks relating to moving and handling and the risk of pressure sores. Both assessments and care plans are regularly reviewed. Risk assessments inform the use of relevant equipment, such as pressure relieving devices, which were in place for one resident seen. The home uses pictorial body maps to outline any bruises, cuts, skin flaps etc, so that they can be effectively treated and monitored. At the time of the inspection some areas on three files seen had been simply ringed and dated on the body maps seen. There was no indication as to what the issue was, or Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 12 when it had healed, although on one body map an area had been ringed in August 2007. On the second day of the inspection the deputy manager confirmed that the body maps were already in the process of being reviewed and updated. A member of staff came and spoke to the deputy manager about one of the areas recently identified of concern, and the deputy manager advised that the GP be called. The home completes the MUST nutritional assessment tool. These assessments are at present kept in one file. The manager discussed keeping the outcomes of the assessment on the individual files of residents so that they can be part of nutritional reviews. Throughout the inspection both hot and cold fluids were made available for residents. One resident was on a fluid chart and said that she was very thirsty on the first day of the inspection at lunchtime. According to the fluid chart and food intake chart she had not had fluids between 8:30 and teatime on one day. It was very clear that fluids are made available throughout the day and that any concerns are fed back to the person in charge. Similarly one resident was poorly and in bed. She asked for a drink when the inspector went into the room. The deputy manager said that regularly fluids were being offered but the resident was often asleep. The offering of fluids or the fact that the resident was asleep was not recorded, as the deputy manager explained was often the case, as the resident was very unwell. This resident did say that she felt well cared for and that staff members were very kind and caring. One resident was choosing to use a toileting sling, as the care plan stated this was preferred; an occupational therapist assessment had not been undertaken to support the home in ensuring safe practice, whilst respecting the resident’s choices. The deputy manager intended to contact an occupational therapist for a review to be undertaken. A resident had a diabetic care plan. It did not contain specific information regarding the person’s health care needs in relation to the medical condition. The deputy manager advised that the condition was being monitored by the district nurses, reflecting that the home appropriately involves external professionals in response to the health care needs of residents. General Practitioners returning survey forms said that overall the home meets the health care needs of people living at the home. They also said that any advice that they give is incorporated into care planning. Four residents returning survey forms said that they usually receive the medical support that they need. Five residents said that this is always the case. A community matron said that she is very impressed with the service, and its anticipation of the medical needs of residents. Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 13 The home keeps medication in a clinic room in a lockable trolley. Normally the trolley is secured to the wall; this was not the case on the first day of the inspection, although the clinic room had not been left unattended and is normally locked when not in use. The trolley was secured on the second day of the inspection. The medicines had not been signed in as received for November. From records of previous months this was not routine, as records had normally been appropriately signed for when they were received into the home. The deputy manager undertakes regular audits of the safe administration of medication, to support safe practice. Records of completed audits were viewed. Where medicines had been handwritten on one Medication Administration Record (MAR) chart seen, the record had been signed by one staff member and counter signed by the staff member verifying the amount received. In the Monitored Dosage system (MDS) medication for one resident had not always been given on the appropriate day. Other medication had been administered on the correct day. Medication for one resident started on a different day to all other medications in the home, causing confusion. The deputy manager intended to highlight this on each MDS sheet, until this could be discussed with the chemist. For another resident there was also only one signature verifying handwritten entries on the MAR chart. The home monitors the temperature of the drugs fridge, which is used to store medicines requiring refrigeration. Two residents were taking warfarin. One resident’s warfarin corresponded with the amount recorded on the MAR chart. The other resident’s medication was also correct but medicine had been removed from different parts of an MDS pack, and it was difficult to assess that the right amount of medication had been given. When audited correct amounts were in place. The actual amount given on each occasion had not been recorded on the MAR chart when the warfarin was prescribed as a variable dose. Temazepam is correctly stored as a controlled drug. As good practice the home records amount given and counts down the amount of medication, two people signing to verify that the correct medication has been given. The home’s trolley is not big enough to carry all medication in use, so medicines have to be transferred during the day from a high cupboard to the trolley. A member of staff reaching the medicines had difficulty in getting them out of the cupboard. It is recommended in this report that a larger trolley is Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 14 obtained so that current medicines in use can be stored together, making it easier to keep medicines in use in an easily accessible order. Throughout the inspection staff were observed providing gentle and sensitive support to residents. A health care professional returning a survey form said that the home usually respects the privacy and dignity of residents. The deputy manager showed the inspector around the home, each resident was pleased to see the deputy manager, recognised her and smiled in response to her kind approach. Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a good range of activities to meet the individual needs of residents. The service listens to feedback regarding food provided and is making every effort to meet the dietary needs of all residents living in the home. EVIDENCE: The home has an activities coordinator. On the first day of the inspection eight residents were taking part in gentle exercise, a pat dog visited and on the second day of the inspection three residents were making Christmas hats. There is a notice board in the home, which displays information regarding forthcoming events and activities going on in the home, as well as news and information. During the visits staff members spent time one-to-one with residents sharing companionship. Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 16 Social care plans were seen on the files seen; as well as detailed family trees on two of the files. During the day residents spent time in the communal areas of the home, or their own rooms according to their personal choices. The home’s AQAA states that the service intends to make the activities programme more varied and stimulating, in the coming months. One relative commented in a survey form that they feel that the home will benefit from a piano. During the visits it was noted that relatives and friends are made very welcome. One relative returning a survey form said that they can visit ‘at any reasonable time.’ Another said that they are kept informed although they live a long way away. All relatives / friends and advocates returning survey forms said that they are kept informed of important issues. Care plans seen reflected the wishes of residents, for example regarding what they would like to do during the day, such as when they like to get up or go to bed. Staff members offered residents choices about every day living activities such as what they would like to drink and also regarding what they would like to do. Some residents enjoyed the activities going on, others preferred to watch and some preferred to do a puzzle or sit and enjoy some quiet in their own rooms. The dining room was decorated ready for Christmas at the time of the visit. It looked very festive and welcoming, providing pleasant surroundings for dining. During the two meals seen some residents chatted whilst they enjoyed their meal. At the time of the visit the home did not have a hot server and there had been some concerns regarding food including its temperature. One person providing feedback during the visit said that the meat could be ‘chewy’. The meat was tender on the two days of the visit, from feedback from residents and staff who sample the food to ensure that good standards are maintained. Two residents responding in survey forms said that they always like the meals at the home, three said usually and one said sometimes. The home has responded to this by setting up a catering committee to include residents, and by asking an external professional to come into the home after Christmas to review the catering arrangements. Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Queensmead is a place where residents can truly feel at home and can raise any day-to-day concerns that they have with confidence that they will be both listened and responded to. Confidence in raising any complaints reflects that residents feel safe, and are protected by the home’s policies and procedures in relation to the protection of vulnerable adults. EVIDENCE: The service has a very clear complaints procedure and recording of any concerns received reflects the open ethos of the service, where residents feel able to say what they think and can be confident that they will be listened and responded to. A three monthly complaints analysis is completed so that it can be ensured that any issues arising are appropriately dealt with, in respect of the overall running of the service. Any concerns raised as part of the home’s internal quality assurance exercise are also taken seriously and are included as part of the home’s annual development plan. Throughout the visits residents and relatives approached the manager, deputy and staff if they had any queries, with an openness, which reflected their sense of being at home and confidant and in control of their own environment. The manager and deputy listened attentively and were never too busy to give time to any resident or their families. Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 18 The service has responded proactively to recent issues regarding people’s comments in respect of the food provided; an action plan has been developed and resident representatives are actively involved in the consultation process. The home has completed a draft summary of training undertaken by staff members, which includes the Protection of Vulnerable Adults. The home has a copy of the Dorset No Secrets adult protection guidance, which is accessible and on display in the office. The manager confirmed that the organization is in the process of amending its own polices and procedures so that they reflect the new Mental Capacity Act. Staff members demonstrate an awareness of the respect for residents, which is required and during the visits treated them with great care. The management have demonstrated in their work that they know how to report incidents of abuse and the procedures that must be followed. Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Queensmead provides a clean and hygienic environment, which is homely for residents. The home’s laundry facilities and some areas of safety in the home do not currently protect and promote the safety and well being of residents and staff. EVIDENCE: Queensmead benefits from a warm, homely and welcoming environment. With Christmas coming up, decorations around the home, give the service a very festive atmosphere. Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 20 A variety of communal areas, provide residents with a choice, in terms of what they would like to do, or whether they would like to be alone, or have some private time with family and friends. The home has accessible toilets, which are close to the communal areas. Individual rooms seen were personalised and reflected the wishes of residents. Taps and sinks and toilet bowls had a build up of lime scale. The manager undertook to ensure that an appropriate cleaner is used to remove the build up of the lime scale, as currently some of the toilet bowls are dark and discoloured. The majority of radiators in the home have been covered to protect residents from the risk of scalding. The manager said that some items of furniture, which covered some radiators in the toilets had been moved since risk assessments had been completed and radiators were hot and exposed, presenting a risk should a resident fall against one. On the second visit the manager was already in the process of reviewing risk assessments and arranging covers where needed. The home has good procedures in place for the control of infection in the home. Staff members wash their hands appropriately and there are accessible hand washing facilities, including alcohol gel. Some soap dispensers had become detached from the wall and were lying on shelves. The laundry is very small. Although some bed linen is sent out of the home the one washer and drier for the number of residents, is poor. Some of the tiling in the laundry is broken and exposed presenting a risk of cross infection. A small store cupboard door, which is a fire door was propped open as there is not much room to get in and out of the storage area to move clothing. The home’s ironing press is stored in the hairdressing room and is difficult to manoeuvre, as it has to be moved out so that ironing can be completed. The manager said that there are plans to enlarge the laundry facilities, as it has been recognised that they are not adequate to easily meet the needs of residents. Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are satisfactory during the day, but are poor at night and insufficient to properly meet the needs of residents. Staff members are well trained, so that they can develop the skills that they need to care for residents and meet their needs. Although staffing levels at night are poor, the adequacy of staffing levels at other times and good training in place have made the overall outcome for this section adequate. EVIDENCE: On the days of the inspection staffing levels seemed satisfactory to meet the needs of residents. However, from the night book, when two care staff members are awake, it stated that additional to the hourly checks that are undertaken of residents, the care staff can responded to up to thirty call bells in one night. A care team manager is always on call, but sleeping in; this member of staff has normally worked the afternoon shift and will be expected to complete the morning shift the next day. The care team manager will be woken should any significant incidents occur in the home. Staff members said that they are then too tired to complete the morning shift and one of the Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 22 management staff has to step in, or another care team manager called into the home. It is not acceptable that a member of staff may be expected to stay awake most of the night should there be any concerns, following the completion of an afternoon shift. On the first day of the inspection it was noted that one resident was very poorly and really wanted a member of staff to stay with her, as she said that she was frightened on her own. At night it would not be possible given the care needs of other residents to give a very poorly resident the one-to-one attention that they need. On the second day of the inspection the manager confirmed that the organization is reviewing night staffing levels in view of the concerns. The three members of staff returning survey forms all said that they feel an awake senior carer or team manager at night would improve the standard of service. A requirement has been made in this report regarding this issue. Currently thirteen staff members have a National Vocational Qualification (NVQ) at level 2 in Care, three members of staff have an NVQ at level 4. The manager has an NVQ at level 4 in Care and is completing the Registered Manager’s Award. The deputy manager holds the RMA and is completing an NVQ at level 4. Two recruitment files were sampled and demonstrated that the home carried out thorough recruitment checks prior to employment. The home has correctly taken action to ensure that they do not hold records such as staff members’ bank statements, which may put them at risk of identity theft. However, in completing this exercise all proofs of identity have been shredded. From evidence of POVA checks on file, these documents have been seen. The home is, therefore, in the process of obtaining suitable proof of identity and a photograph from staff members. An induction record was seen on one file sampled. At present boxes are ticked and signed, when the learner has achieved competency in that area of practice. The deputy manager is in the process of completing a summary record of training, so that training needs can be monitored and identified. She confirmed that staff members would be updated in mandatory areas of practice, as required. Copies of certificates on individual files demonstrated that staff members had undertaken relevant training. Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and resident focused in its approach to the organization and day-to-day running of the home in the best interests of the people who live at Queensmead, protecting people’s financial interests and consulting them regarding the running of the home. EVIDENCE: The deputy manager assisted the inspector on the first day of the inspection. The manager was observed ensuring that the day-to-day running of the home was maintained and individual residents’ interests considered. The manager and deputy are a strong management team, whose care for residents was Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 24 reflected in the running of the home and their responses when they engaged with residents. Both possess and are working to appropriate qualifications in care that will support their practice in the management of the home. The home has a thorough internal quality assurance system that is monitored by an outside professional, giving the home a realistic picture of areas for improvement. At the centre of this is consultation with residents and their families. This includes questionnaires and residents’ meetings to discuss areas which people living in the home want to talk about. The home has come up with inventive ways to meet the needs of residents, which have been identified from audits undertaken. For example, in ensuring that attention is given to specific areas of personal hygiene; one of the staff does nail care twice a week, making this part of the shared experiences enjoyed in the home. The home keeps the individual monies of residents separately. Records of two residents monies checked corresponded with amounts held. Receipts were not seen on this occasion; they are kept separately. According to the AQAA returned by the home, some policies are overdue for review. The manager confirmed that this is in the process of being undertaken. There are a lot of falls in the home. However detailed accident and incident records are kept and are audited and action is taken to minimise risks. Most importantly residents are supported to be independent, and this means being able to move about the home when they choose. From the AQAA returned the home ensures that facilities and services are regularly checked and maintained in the home. The fire log showed that regular routine checks are carried out of fire equipment in the home. A fire alarm test was carried out during the inspection. Draft summary record of training showed that most staff are updated in key areas of health and safety training. The summary needs to be completed so that there is an overview from which training needs can be identified. Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 4 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 3 X X X X X 2 2 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered person must ensure that all care plans are kept up to date with residents’ health and welfare needs. The registered person must review staffing levels at night and ensure that that there are sufficient staff members on duty to safely meet the needs of residents. Timescale for action 30/01/08 2. OP27 18 20/12/07 Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The registered person should ensure that medicines are recorded, held and administered as prescribed at all times, protecting residents in the home by safe practice. The registered person should ensure that medication is stored so that it can be easily and safely accessible at all times. The registered person should consider providing improved laundry facilities so that residents’ clothing can be easily laundered, ironed and returned to them. Two references should be obtained before the appointment of all new members of staff. The registered person should ensure that the summary record of training is completed, so that training needs can be monitored, identified and training appropriately implemented. 2. OP9 3. OP26 4. 5. OP29 OP30 Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Queensmead DS0000026862.V355382.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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